Suspension of zinc oxide nanoparticles (ZnO-NP) as an intraoperative wound irrigation to prevent infection after fracture fixation

Abstract

Background: Infection after fracture fixation (IAFF) associated with an implant in orthopaedic surgery is a feared complication, leading to non-union, loss of function, amputation, and even mortality and morbidity to the patient. A biofilm formation on the implant surface increases the difficulty of treatment. Therefore, surgical infection prevention with an effective antiseptic solution is required. This study aims to reveal more about the antibacterial effect of ZnO-NP suspension, particularly Staphylococcus aureus and its biofilm, in preventing surgical infection. Method: An in vitro experimental study with a posttest-only control group design was used to see the antimicrobial activity and inhibitory effect of Staphylococcus aureus biofilm formation between a 20% zinc oxide nanoparticle (ZnO-NP) suspension (20 mg/mL) compared to 0.3% povidone-iodine solution. The statistical result was tested using an independent t-test antibacterial activity. Meanwhile biofilm identification was evaluated using Mann-Whitney & Kruskal Wallis test for each group. Result: 20% ZnO-NP suspension has a minimum inhibitory concentration at 4 μg/mL and a minimum bactericidal concentration at 16 μg/mL, same as 0.3% povidone-iodine administration and its statistically significant (p-value 0.001). Minimum biofilm inhibitory concentration was seen at a concentration of 20% ZnO-NP suspension of 2 μg, while at higher doses, it showed lysis of bacterial cells. Conclusion: 20% ZnO-NP suspension is a promising solution for preventing surgical infection due to its antibacterial and antibiofilm effects.